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Optimizing lung transplant outcomes in the adult and pediatric patient.

Optimizing lung transplant outcomes in the adult and pediatric patient. Cynthia S. Herrington, MD Associate Professor of Surgery Keck School of Medicine University of Southern California. Optimizing Lung Transplant Outcomes. Holy SRTR

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Optimizing lung transplant outcomes in the adult and pediatric patient.

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  1. Optimizing lung transplant outcomes in the adult and pediatric patient. Cynthia S. Herrington, MD Associate Professor of Surgery Keck School of Medicine University of Southern California

  2. Optimizing Lung Transplant Outcomes Holy SRTR International practices and outcomes and where the pitfalls exist --ISHLT How to asses a program when the wheels fall off the bus

  3. Optimizing Lung Transplant Outcomes The Adults

  4. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 AGE DISTRIBUTION OF ADULT LUNG TRANSPLANT RECIPIENTS BY ERA

  5. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival (Transplants: January 1994 - June 2008)

  6. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONProcedure Type within Indication, by Year

  7. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Era (Transplants: January 1988 – June 2008)

  8. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group(Transplants: January 1990 – June 2008)

  9. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival by Gender(Transplants: January 1990 – June 2008)

  10. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis(Transplants: January 1990 – June 2008)

  11. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATIONKaplan-Meier Survival By Diagnosis Conditional on Survival to 1 Year(Transplants: January 1990 – June 2008)

  12. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTS (1996-6/2008)Risk Factors for 1 Year Mortality Reference group = COPD/Emphysema, Single lung (N=13,079) *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis,bronchiectasis,alpha-1 antitrypsin deficiency, retransplant and LAM.

  13. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTS (1996-6/2008)Risk Factors for 1 Year Mortality (N=13,079)

  14. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTS (1996-6/2008) Risk Factors for 1 Year Mortality (N=13,079)

  15. ADULT LUNG TRANSPLANTS (1996-6/2008)Borderline Significant Risk Factors for 1 Year Mortality ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 (N=13,079)

  16. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTS(1/1996-6/2008) Risk Factors for 1 Year MortalityRecipient Age

  17. ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 (N=7,609)

  18. ADULT LUNG TRANSPLANTS (1996-6/2004) Risk Factors for 5 Year Mortality ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Reference group = COPD/Emphysema, Single lung (N=7,609)

  19. ADULT LUNG TRANSPLANTS (1996-6/2004)Risk Factors for 5 Year Mortality ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 (N=7,609)

  20. ADULT LUNG TRANSPLANTS (1996-6/2004) Borderline Significant Risk Factors for 5 Year Mortality ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Reference diagnosis group = COPD/Emphysema, Single lung (N=7,609) *Other = All diagnoses other than COPD, IPAH, IPF, cystic fibrosis, pulmonary fibrosis,bronchiectasis,alpha-1 antitrypsin deficiency, retransplant and LAM.

  21. ADULT LUNG TRANSPLANTS(1/1996-6/2004)Risk Factors for 5 Year MortalityRecipient Age ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  22. ADULT LUNG RECIPIENTSLongitudinal Analysis Functional Status of Surviving Recipients(Follow-ups: April 1994 – June 2009)For the Same Patients ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  23. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG RECIPIENTSEmployment Status of Surviving Recipients(Follow-ups: April 1994 – June 2009)

  24. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG RECIPIENTS: Rehospitalization Post-transplantof Surviving Recipients(Follow-ups: April 1994 - June 2009)

  25. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2009)

  26. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Prevalence in Survivors within 1 and 5 Years Post-Transplant (Follow-ups: April 1994 - June 2009)

  27. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 POST-LUNG TRANSPLANT MORBIDITY FOR ADULTSCumulative Prevalence in Survivors within 10 Years Post-Transplant (Follow-ups: April 1994 - June 2009)

  28. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME For Adult Lung Recipients (Follow-ups: April 1994-June 2009)Conditional on Survival to 14 days

  29. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 FREEDOM FROM BRONCHIOLITIS OBLITERANS SYNDROME STRATIFIED BY INDUCTION USEFor Adult Lung Recipients (Follow-ups: April 1994-June 2009)Conditional on Survival to 14 days

  30. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 FREEDOM FROM MALIGNANCYFor Adult Lung Recipients(Follow-ups: April 1994-June 2009)

  31. ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death(Deaths: January 1992- June 2009) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  32. Optimizing Lung Transplant Outcomes Children

  33. AGE DISTRIBUTION OF PEDIATRIC LUNG RECIPIENTSBy Year of Transplant ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 NOTE: This figure includes only the pediatric lung transplants that are reported to the ISHLT Transplant Registry. Therefore, these numbers should not be interpreted as the rate of change in pediatric lung procedures performed worldwide. Analysis includes living donor transplants

  34. NUMBER OF CENTERS REPORTING PEDIATRIC LUNG TRANSPLANTS BY CENTER VOLUME ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 Analysis includes living donor transplants

  35. PEDIATRIC LUNG TRANSPLANTS:DIAGNOSIS DISTRIBUTION BY LOCATIONTransplants between January 2000 and June 2009 ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 • NOTE: Unknown diagnoses were excluded from this tabulation. • Total number of transplants reported: • Europe = 237 • North America = 498 • Other = 41 Analysis includes living donor transplants

  36. LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group (Transplants: January 1990 - June 2008) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  37. PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Procedure Type (Transplants: January 1990 - June 2008) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  38. PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Age Group (Transplants: January 1990 - June 2008) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  39. PEDIATRIC LUNG TRANSPLANTATIONConditional Kaplan-Meier Survival by Age Group(Transplants: January 1990 - June 2008) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  40. PEDIATRIC LUNG TRANSPLANTATIONKaplan-Meier Survival by Donor Type for Recipients Age 12-17 Years(Transplants: January 1990 - June 2008) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  41. PEDIATRIC LUNG RE-TRANSPLANTS Between January 1994 and June 2009 ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  42. PEDIATRIC LUNG RETRANSPLANTSSurvival for Transplants Performed Between January 1994 and June 2008 ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  43. PEDIATRIC LUNG RECIPIENTSLongitudinal Analysis Functional Status of Surviving RecipientsFor the Same Patients(Follow-ups: April 1994-June 2009) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  44. PEDIATRIC LUNG RECIPIENTS Rehospitalization Post-transplant of Surviving Recipients(Follow-ups: April 1994 - June 2009) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  45. POST-LUNG TRANSPLANT MORBIDITY FOR PEDIATRICSCumulative Prevalence in Survivors within 1 Year Post-Transplant (Follow-ups: April 1994 - June 2009) ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  46. Optimizing Lung Transplant Outcomes Optimizing the outcomes…..evaluate program vulnerabilities by doing root cause analysis on each death Take risks proportional to the stability of the program

  47. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANT RECIPIENTS: Cause Of Death(Deaths: January 1992- June 2009)

  48. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG RECIPIENTSMaintenance Immunosuppression at Time of Follow-upFor follow-ups between January 2002 through June 2009 Analysis limited to patients receiving prednisone NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up

  49. ADULT LUNG RECIPIENTSKaplan-Meier Survival by Maintenance Immunosuppression Combinations Conditional on Survival to 1 Year (Transplants: January 2000-June 2008)Analysis limited to patients receiving prednisone ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141

  50. ISHLT 2010 J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 ADULT LUNG TRANSPLANTATION: Indications for Single Lung Transplants (Transplants: January 1995 - June 2009) *Other includes: Sarcoidosis: 2.0% Bronchiectasis: 0.4% Congenital Heart Disease: 0.3% LAM: 0.9% OB (non-ReTx): 0.5% Miscellaneous: 5.3%

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